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Musculoskeletal I (second exam/practical) > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What are the 3 goals of exercise intervention for arthritis?

A
  • Slow or reverse the body’s response to joint pathology by increasing strength, flexibility, endurance, and by decreasing pain
  • Improve impairments, functional limitations, and disabilities associated with arthritis
  • Improve health due to cardiovascular, strengthening, ROM, and stretching
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2
Q

How does osteoarthritis begin? What is the next step

A
  • Asymmetric cartilage loss –> Abnormal forces on the joint

- This leads to soft-tissue imbalance, joint malalignment, and bony hypertrophy

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3
Q

How does rheumatoid arthritis begin? What is the next step?

A
  • Pannus formation
  • Erosion of cartilage and bone
  • Cartilage destruction
  • Bone destruction
  • Soft tissue destruction
  • Joint capsule fibrosis
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4
Q

What does the anatomic damage of RA lead to?

A
  • Joint malalignment
  • Instability
  • ROM loss
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5
Q

Which arthritis is inflammatory?

A

RA

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6
Q

Which arthritis is localized?

A

OA

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7
Q

Which arthritis is systemic?

A

RA

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8
Q

Which arthritis affects several organ systems?

A

RA

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9
Q

What is the function of articular cartilage, and how it affected by OA and RA?

A

Function: Shock absorption, joint congruence
OA: Thickening to softening, to thinning to loss
RA: Erosion

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10
Q

What is the function of the synovium, and how is it affected by OA and RA?

A

Function: Secretes synovial fluid for cartilage nutrition, lubrication, and stability
OA: Abnormal joint alignment stresses
RA: Microvascular lining cells activated by inflammatory process, pannus formation

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11
Q

What is the function of ligaments, and how are they affected by OA and RA?

A

Function: Stability, reinforce capsule, and limit movement, guide movement
OA: Abnormal joint alignment stresses
RA: Erosion; weakens

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12
Q

What is the function of muscles, and how are they affected by OA and RA?

A

Function: Reinforce joint capsule, reflex joint protection, move joints
OA: Immobility shortens pain, causes gaurding and reflex inhibition, leading to weakness
RA: Joint deformity interferes with peak torque, immobility shortens muscles, myositis weakens, pain and effusion cause gaurding, reflex inhibition leads to weakness

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13
Q

What is the function of bone, and how is it affected by OA and RA?

A

Function: Structural support
OA: Subchondral bone remodeling changes shock absorbing properties, and joint margin spurring leads to bony blockage and pain
RA: Erosion leads to joint deformity, bony blockage, pain

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14
Q

What is impact of OA and RA on extra-articular systems?

A

OA: Increased energy expenditure from abnormal movement patterns
RA: Myositis, anemia, sleep disruption, fatigue, increased energy expenditure from abnormal movement patterns.

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15
Q

Describe class I, II, III, and IV RA in terms of function.

A

Class I: Perform usual ADLs
Class II: perform ADLs and vocational activities, limited in avocational activities
Class III: Perform ADLs, but limited in vocational and avocational activities
Class IV: Limited in ability to perform ADLs, vocational, and avocational activities

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16
Q

What may be present on x-ray in stage I RA?

A
  • Osteoporosis
17
Q

What may be present on x-ray in stage II RA?

A
  • Osteoporosis
  • With or without subchondral bone destruction
  • Slight cartilage destruction
18
Q

What may be present on x-rays in stage II RA?

A
  • Cartilage destruction
  • Bone destruction
  • Osteoporosis
19
Q

Describe the presence of joint deformities, muscle atrophy, extra-articular soft tissue lesions in stage II, III, and IV RA.

A

Stage II:
- No joint deformities; possible limitation of mobility
- Muscle atrophy
- Extra-articular soft tissue lesions (nodules and tenosynovitis)
Stage III:
- Joint deformity such as subluxation, ulnar deviation, or hyperextension
- Extensive muscle atrophy
- Extra-articular soft tissue lesions (nodules, tenosynovitis)
Stage IV:
- Fibrous or bony ankylosis

20
Q

What are the 4 components of an appropriate exercise regimen for prevention of arthritis?

A
  • Maintain appropriate body weight
  • Sustain good postural alignment
  • Develop good muscular strength and length
  • Correct movements during functional activities
21
Q

What are the 4 components of an exercise regimen for a patient with osteoarthritis?

A
  • Decrease pain and inflammation
  • Re-establish muscle length and strength around joint
  • Address adaptive changes in proximal and distal joints
  • Performance of basic functional tasks
22
Q

How does exercise prescription differ for a patient with RA from a patient with OA?

A
  • The Pt should be taught how to recognize symptoms, and modify activity according to symptom development and stage of disease
23
Q

Describe the 8 step progression of pain due to arthritis and its effect on function.

A
  • Pain, swelling, splinting
  • Disuse atrophy
  • Reduced protective reflexes
  • Further cartilage breakdown
  • Disruption of soft tissue balance
  • Inefficient movement/ muscle patterns
  • Decreased cardiovascular activity
  • Further activity reduction
24
Q

How does therapeutic exercise help prevent the progression of pain and loss of function?

A
  • Restores muscle balance
  • Restores ROM
  • Restores CV conditioning
  • Modalities help control pain
25
Q

What are 3 factors that can diminish range of motion from arthritis?

A
  • Stiffening/ shortening of muscles or tendons from spasm, guarding, or habitual postures
  • Capsule stiffness or contracture
  • Loss of joint congruity secondary to bony deformity
26
Q

How is muscle performance addressed in Rheumatoid arthritis?

A
  • 1 - 2 daily applications of PROM (large joints) and AROM (small joints)
  • Single submaximal isometric contractions, 6 secs on/ 20 secs off
  • Repeat at various angles
27
Q

How is muscle performance addressed in an acute phase of osteoarthritis?

A
  • Isometric contractions
28
Q

How muscle performance addressed in osteoarthritis once pain and swelling decrease?

A
  • Dynamic contractions as appropriate
29
Q

For what types of arthritis is CV training an important part?

A

Class I and II RA, and all OA

30
Q

What specific type of CV training is particularly helpful with arthritis? Why?

A

Aquatic Therapy:

  • Allows performance of movement patterns that may not be possible on land because of balance or strength deficits
  • Provides muscle relaxation
  • Modifies pain perception through sensory stimulation
31
Q

When should a joint be protected during strengthening?

A
  • When ligament or capsular laxity exists
32
Q

When should muscle balance be restored in arthritis?

A
  • Splinting
  • Postural habit
  • Pain inhibition
  • -> These have weakened muscles groups around one or more joints
33
Q

What are 3 special general considerations for patients with arthritis and exercise?

A
  • Normalize specific joint movement patterns
  • Restore functional activities
  • Treat pain during and after

Musculoskeletal I (second exam/practical) (7 decks)

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